Have Heart Failure? Think Iron as Well as CoQ, B1, Magnesium, Carnitine, Ribose and Lipoic Acid!

Usually when I talk about supplements that help heart failure I mention the mitochondrial
energy producing nutrients that help the heart muscle "squeeze" harder like CoQ10
(ubiquinol) 400-900 mg/d, magnesium 300-500 mg/d, ribose 5-15 grams per day,
L-carnitine 1000-2000 mg/d (measure TMAO), vitamin B1 50-100 mg/d and alpha
lipoic acid 300 mg/d. But these studies suggested heart failure patients be assessed
for iron deficiency and supplementation with either oral iron or I.V. iron was of benefit.

CONCLUSION: Three hundred and four ambulatory symptomatic heart failure patients
with a left ventricular ejection fraction ≤45%, elevated natriuretic peptides, and iron
deficiency (ferritin <100 ng/mL or 100-300 ng/mL if transferrin saturation <20%)
treated with IV iron, as ferric carboxymaltoses (FCM), in undiluted I.V. bolus injections
of 10 or 20 mL (equivalent to 500 or 1000 mg of iron) administered over at least 1
minute in doses based on the subjects weight and hemoglobin level, between 500
and 2000 mg iron in the therapy phase, (baseline to Week 6), and thereafter
maintenance FCM dosing of 500 mg iron at each of Weeks 12, 24, and 36 over a
1-year period, resulted in sustainable improvement in functional capacity, symptoms,
and QoL and may be associated with risk reduction of hospitalization for worsening
heart failure.

“Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in
patients with symptomatic heart failure and iron deficiency” Eur Heart J. 2015 Mar 14;
36(11):657-68. 51346 Piotr Ponikowski, MD Department of Heart Diseases, Medical
University, Wroclaw, Poland Department of Cardiology, Center for Heart Diseases,
Clinical Military Hospital, Weigla 5 53-114, Wroclaw, Poland piotrponikowski@4wsk.pl

CONCLUSION: Iron-deficient heart failure with reduced ejection fraction (HFrEF)
patients (n=105) who received oral iron supplementation over 180 days had ferritin
(from median 39 ng/mL to 75 ng/mL), Tsat (from 10% to 21%), iron (from 34 μg/dL
to 69 μg/dL), and hemoglobin (from 10.4 g/dL to 11.6 g/dL) values increase, while
total iron-binding capacity decreased (from 343 to 313 μg/dL) at 164 days after the
initiation of oral iron supplementation. Oral iron supplementation improved iron stores
similarly to previously reported results with the use of intravenous iron repletion in
HFrEF patients, suggesting that oral iron is probably a beneficial intervention strategy in HFrEF.

“Repletion of Iron Stores With the Use of Oral Iron Supplementation in Patients With
Systolic Heart Failure.” J Card Fail. 2015 Aug;21(8):694-7. 51347 Gregory D. Lewis,
MD, Assistant Professor of Medicine, Cardiology Division, Department of Medicine,
 Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB-8,
Boston, MA 02114 (617) 726-9554/ (617) 726-4105 (FAX). glewis@partners.org.

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